B80-2-01 Adaptive Servo-ventilation for Obstructive Sleep Apnea Improves Right Ventricular Strain Early After Acute Myocardial Infarction: A Secondary Analysis of the Randomized TEAM-ASV I Trial

Abstract Rationale After acute myocardial infarction (AMI), patients with sleep-disordered breathing (SDB) are at increased risk of developing right ventricular (RV) enlargement. Some data from observational studies suggest a beneficial effect of positive airway pressure therapy on RV function. Adaptive servo-ventilation (ASV) has been proposed as a therapeutic intervention to reduce infarct expansion early after AMI. The aim of this study was to evaluate the effect of ASV therapy on right ventricular function and geometry. Methods This study was designed as a secondary analysis of the multicenter, randomized, open-label TEAM-ASV I trial (NCT02093377), which enrolled patients with first-time AMI and SDB (apnea-hypopnea index (AHI) ≥15 events per hour). We analyzed the intention-to-treat population with available cardiac magnetic resonance (CMR) imaging data at ⩽ 5 days and 12 weeks after AMI. Volumetric (RVEDV: RV end-diastolic volume; RVESV: RV end-systolic volume) and functional (RV strain; RVEF: RV ejection fraction; RFCO: RV cardiac output) parameters were quantified via CMR. Results Forty-five patients (62 ± 10 years, 76 % men, BMI 30.5 ± 6.3 kg/m², AHI 33 ± 18 events per hour) were randomized to early ASV treatment in addition to standard care of AMI (n = 23) and standard care alone (control, n = 22). ASV resulted in a significant improvement in RV strain (-4.9 ± 4.3 %) compared with control (-1.5±5.3 %, p = 0.028). Change in RVEF (ASV 3.1 ± 2.0 % vs. control -0.3 ± 1.6 %) suggested a favorable numerical trend. Improvement in RV strain was confined to patients with obstructive sleep apnea (ASV -6.2 ± 5.5 % vs. control -0.7 ± 4.2 %, p = 0.010) and not central sleep apnea (ASV -3.9 ± 3.2 % vs. control -3.4 ± 7.4 %, p = 0.826). Conclusion ASV therapy for obstructive sleep apnea early after AMI improved RV strain, a sensitive marker of early contractile dysfunction. Larger randomized trials are warranted to validate these findings. This abstract is funded by: ResMed Foundation, ResMed Germany